developed in the US to measure nursing work environments (NWEs) has not yet been used in England. Aims To evaluate the structure of the EOMII Scale, and to describe the impact of different aspects of the NWE on nurse-assessed care quality (NACQ) using data from nurses working in England Methods A mixed-methods sequential explanatory design was utilised. First, in a cross-sectional survey study, 247 RNs in 29 wards in two NHS hospitals completed the EOMII and a single item measuring NACQ in 2012. Principal Component Analysis (PCA) was used to evaluate the structure of the EOMII. Correlation and regression analyses were used to describe relationships between factors and NACQ. Second, comments made by nurses on questionnaires were analysed. Third, a purposive sample of 48 RNs were recruited to explore their understanding of the concept of autonomy, using short-structured interviews. Results PCA identified a solution with explanatory variance of 45.25%. Forty items loaded on five factors: ward manager support, working as a team, concern for patients, organisational autonomy, and constraints on nursing practice. In correlation analysis, each of the factors was significantly associated with NACQ (p < .001). In a hierarchical multiple regression analysis, four factors were associated with NACQ. Only one factor, organisational autonomy, was not a significant predictor (β=.02, t = .24, ns) of NACQ. Analysis of the interviews revealed that nurses in this sample did not relate autonomy to involvements in managerial/higher level decisions, but limited their discussions to decision-making at the ward team level. Conclusion Results suggest that EOMII does measure important aspects of NWE and that each of the factors identified is related to NACQ. Analysis of qualitative data suggests several hypotheses about differences in the meaning of autonomy that could be tested in future research.
